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CEN Case Reports

, Volume 3, Issue 2, pp 202–205 | Cite as

Graft versus host disease-dependent renal dysfunction after hematopoietic stem cell transplantation

  • Yaeko Motoyoshi
  • Akifumi Endo
  • Masatoshi Takagi
  • Tomohiro Morio
  • Eisaku Ito
  • Michio Nagata
  • Shuki Mizutani
Case Report

Abstract

Nephropathy is an important complication in hematopoietic stem cell transplantation (HSCT) wherein multifactorial causes, i.e., radiation, drug toxicity, graft versus host disease (GVHD), are thought to contribute renal dysfunction. Here, we report a 10-year-old boy with high-risk acute myelocytic leukemia and severe but partially reversible renal dysfunction. The patient initially received umbilical cord blood transplantation (UCBT) with CY 120 mg/kg and kidney unshielded 12 Gy of total body irradiation. After the leukemic relapse, he received allogenic bone marrow transplantation (BMT) 270 days after the first transplantation. Two months later, his renal function started to deteriorate and urinary protein increased gradually to 1 g/day. Four months after BMT, by the symptoms of severe GVHD, the dose of tacrolimus, utilized to avoid GVHD, was increased although his serum Cre level elevated to 2.97 mg/dL. Serum Cre level improved to 2.0 mg/dL paralleled with GVHD improvement. Renal histological findings showed severe interstitial edema, features of thrombotic microangiopathy (TMA), and C4d deposition along the glomerular capillaries and peritubular capillaries. We suggested that control of GVHD had benefitted to ameliorate renal function of the patient. Treatment for GVHD improved renal dysfunction and TMA of our patients. Moreover, renal biopsy was powerful to elucidate the exact origin of renal dysfunction after HSCT.

Keywords

Total body irradiation Calcineurin inhibitor nephrotoxicity Thrombotic microangiopathy Bone marrow transplant nephropathy Mesangiolysis Interstitial edema 

Notes

Acknowledgments

The authors are deeply grateful to Shigeru Horita and Motoshi Hattori (Tokyo Women’s Medical University) for C4d staining.

Conflict of interest

All the authors have declared no competing interest.

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Copyright information

© Japanese Society of Nephrology 2014

Authors and Affiliations

  • Yaeko Motoyoshi
    • 1
  • Akifumi Endo
    • 1
  • Masatoshi Takagi
    • 1
  • Tomohiro Morio
    • 1
  • Eisaku Ito
    • 2
  • Michio Nagata
    • 3
  • Shuki Mizutani
    • 1
  1. 1.Department of Pediatrics, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of Pathology, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan
  3. 3.Department of PathologyUniversity of TsukubaIbaragiJapan

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